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Letter to the Editor   |    
Am J Psychiatry 2005;162:1228-1229. doi:10.1176/appi.ajp.162.6.1228

To the Editor: There are errors in the content of the article on infanticide by Margaret G. Spinelli, M.D. (1). I served as a media consultant for the case and discussed it with both defense and prosecution experts in November 2003 at the annual meeting of the American Academy of Psychiatry and the Law. Dr. Spinelli cites the high-publicity case of Andrea Yates as an example of postpartum psychosis and is critical of many who were involved.

Although she states that the expert opinions offered "differed remarkably," this is false. Park Elliott Dietz, M.D., Ph.D., the state’s lead expert, and Phillip J. Resnick, M.D., the defense lead expert, both reached similar diagnostic conclusions of schizophrenia and schizoaffective disorder, respectively. In fact, all of the experts involved as well as outside experts consulted by media outlets reached similar diagnoses based on the available information. To claim that there was "little intervention from the psychiatric community" is to belittle the hundreds of hours spent by experts.

In addition, Dr. Spinelli suggested that the Federal Circuit Courts of Appeals used the Model Penal Code/American Law Institute’s "not guilty by reason of insanity" test. In 1984, in the aftermath of the Hinckley case, Congress passed the Insanity Defense Reform Act, which governs all federal courts. Although Dr. Spinelli claims that "about half" of the states use the Model Penal Code/American Law Institute test, only 16 out of the 50 states currently use this test.

Although there is no doubt that Ms. Yates was and still is mentally ill, her condition simply is not a just postpartum condition. DSM-IV could be faulted because it requires onset of psychosis to occur within 4 weeks of birth; that specific criterion was not met. Ms. Yates had this serious mental illness before she gave birth to her last child, 6 months before the killings. Six months postpartum is hardly a time when a woman is still experiencing the sudden hormonal changes associated with delivery. The Yates case is not a classic example or even a good example of postpartum psychosis.

Mental illness does not de facto equate to "not responsible." This decision is left to the judge or jurors. They apply the law to the medical circumstances. As the outcome shows, the jury in Texas required 3 hours to reach their guilty decision but only 35 minutes to rule out the use of the death penalty. To those who served on the jury, the evidence was clear. The outcome was also no surprise to the forensic psychiatrists in the case, who realized that the insanity standard being used in the Yates case would be very difficult to reach, given the facts of the case and her testimony that she knew her conduct was illegal.

Although Dr. Spinelli faults the treating psychiatrist for stopping haloperidol 2 weeks before the tragedy for "unclear reasons," I would suggest that a review of the medical records suggests a sound medical reason for stopping the medication: akathisia.

Most forensic psychiatrists welcome legislative deliberation on the topics of neonaticide and infanticide; the current penal codes do not really fit the behavior about which we are forced to educate the public and the judicial system. The British Infanticide Act (2) might well provide some guidance.

Spinelli MG: Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry  2004; 161:1548–1557
Infanticide Act of 1938, 1 & 2 Geo 6, Ch 36 sec 1 (1938)


Spinelli MG: Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry  2004; 161:1548–1557
Infanticide Act of 1938, 1 & 2 Geo 6, Ch 36 sec 1 (1938)

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